Provider, Team, and System-Level Variance in Surgical Outcomes: Disentangling Individual, Team, and Structural Contributions to Care Quality

Surgical outcomes are shaped not only by patient characteristics and procedural factors, but by who delivers care and how that care is organized. A growing body of evidence points to meaningful variation at the level of the individual surgeon, the surrounding care team, and the broader system in which both operate. Studies have shown that outcomes can shift when surgeons move to a new institution, that substantial variability persists even within high-volume, well-regarded centers, and that factors long assumed to predict complications may in some cases reflect provider-specific effects rather than patient or procedural risk. Together, these findings raise an important question for surgical quality improvement: how much of the outcome we attribute to a diagnosis, a procedure, or a protocol is really attributable to the people and structures delivering the care?

This Research Topic aims to bring together original research, registry-based analyses, and systematic reviews that examine how surgical outcomes vary by provider, team, and system, and what drives that variation. We welcome contributions addressing, but not limited to, the following areas: the effect of surgeon-team continuity and disruption (for example, when surgeons change institutions or teams) on the efficacy of care; re-examination of previously reported outcome predictors to determine whether they reflect provider-level effects rather than patient or procedural factors; comparative analyses of outcome variance within and across institutions after adjustment for case mix and patient risk; and methodological approaches for isolating individual, team, and system-level contributions to surgical outcomes, including appropriate strategies for risk-adjustment and confounding control.

By bringing together evidence from multiple surgical subspecialties and health systems, this Research Topic seeks to advance a more precise understanding of where surgical quality comes from and how it can be measured, attributed, and ultimately improved. We invite Original Research articles, Systematic Reviews, and Brief Research Reports from surgeons, health services researchers, and outcomes scientists working in this space.

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Classification
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• ... View all formats

Articles that are accepted for publication by our external editors following rigorous peer review incur a publishing fee charged to Authors, institutions, or funders.

Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Classification
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Review
• Study Protocol
• Systematic Review
• Technology and Code

Keywords: surgical outcomes, provider-level variation, surgeon volume, care team continuity, risk adjustment, quality improvement, health services research, case-mix adjustment

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.